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Institute of Medicine (IOM) View The “American Recovery and Reinvestment Act of 2009” (ARRA) provides a meaningful, initial down payment on CER (comparative effectiveness research) that will strengthen the delivery of evidence-based medicine while preserving physician decision-making autonomy. Title VIII of ARRA includes a $1.1 billion appropriation to fund additional CER administered by the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), and the Secretary of the Department of Health & Human Services (HHS). This funding will “be used to conduct or support research to evaluate and compare clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition” as specified in the Conference Report concerning the CER provisions. The corresponding statutory language of ARRA signifies the preeminence of clinical outcome-based research and analysis (as opposed to research driven by cost analysis and cost containment). Also, the Conference Report “recognizes that ‘a one-size- fits-all’ approach to patient treatment is not medically appropriate.” Source: CMS Report 5 (A-08)

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Definition of Best Practice A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. A commitment to using the best practices in any field is a commitment to using all the knowledge and technology at one's disposal to ensure success. The term is used frequently in the fields of health care, government administration, the education system, and more.

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Definition of Evidence-Based Medicine Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. [1] It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests. [2] Evidence quality can range from meta-analyses and systematic reviews of double-blind, placebo- controlled clinical trials at the top end, down to conventional wisdom at the bottom.evidence-based practiceevidencescientific methoddecision making [1]treatments [2] meta-analysessystematic reviewsdouble-blindplacebo- controlledclinical trialsconventional wisdom EBM/EBP recognizes that many aspects of health care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBP, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable.quality-value-of-lifeprediction

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US Preventative Services Task Force Level I: Evidence obtained from at least one properly designed randomized controlled trial. randomized controlled trial Level II-1: Evidence obtained from well-designed controlled trials without randomization.randomization Level II-2: Evidence obtained from well-designed cohort or case- control analytic studies, preferably from more than one center or research group.cohortcase- control Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

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Categorizations Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients. Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations. Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients. Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

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Additional Explanations Clinical algorithms are instructions relating to the management of clinical issues, which are organized on the basis of conditional, branching logic Clinical informatics is deals with clinical practice, and extends into medical billing & database expert systems Clinical pathways are interlinked clinical practice guidelines which organize, sequence and time the care given to a typical uncomplicated patient Schoenbaum SC (ed.) (1995) Using clinical practice guidelines to evaluate quality of care. V1. US Department of Health & Human Services, Bethesda, MD).

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Evaluating Internet Data BACKGROUND: The advent of virtually free Internet access has opened large vistas of health care information to those willing to invest a small amount of time and energy learning how to perform searches using browser software. Health care providers, organizations, and professional associations, among many others, publish "best practices" information for both administrative and clinical audiences, making these recommendations among the fastest-growing types of health care information appearing on the World Wide Web. The problem is how to find best practices among the wealth of resources on the Internet and then how to separate the proverbial wheat from the chaff. WHO IS SEEKING BEST PRACTICES ON THE INTERNET? Best practice describes a process or technique whose employment results in improved patient and/or organizational outcomes. Health care providers, managed care organizations, administrators, payers, and policy analysts are all interested in improving the quality of health care and are likely to be customers of best practices informational resources. HOW TO EVALUATE THE QUALITY OF BEST PRACTICES INFORMATION? Once the information is available on the Internet, the problem for the searcher shifts from one of quantity to quality. The best practices information seeker should stop and ask a number of questions about the quality of information, its sources, and the methods used to obtain it. CONCLUSION: The "truth" may be out there some-where in cyberspace, but locating best practices information and evaluating its quality require new skills and patience and time to practice and develop them to the point of efficiency.